Key result
The change in neutrophil-to-lymphocyte ratio (ΔNLR) after ablation was independently and significantly associated with late recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation (HR 1.13).
Why the study?
NLR changes and late recurrences of AF after catheter ablation depending on AF type (paroxysmal vs persistent) remain unknown.
Does the change in neutrophil-to-lymphocyte ratio (ΔNLR) predict late recurrence of atrial fibrillation after catheter ablation in patients with paroxysmal or persistent AF?
Observational (n=633)
No
Does the change in neutrophil-to-lymphocyte ratio (ΔNLR) predict late recurrence of atrial fibrillation after catheter ablation in patients with paroxysmal or persistent AF?
Effect estimate: HR 1.13 (95% CI 1.01-1.26)
p-value: p=0.029
The change in neutrophil-to-lymphocyte ratio after pulmonary vein isolation is a useful independent predictor of late AF recurrence specifically in patients with paroxysmal, but not persistent, atrial fibrillation.
ΔNLR may aid post-ablation risk stratification in paroxysmal AF; leaves open prospective validation and applicability to persistent AF.
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) has been proposed as an indicator of a systemic inflammatory response. There are baseline differences in the inflammation status between paroxysmal atrial fibrillation (PAF) and persistent AF (PerAF). The NLR changes and late recurrences of AF (LRAF) after ablation depending on the AF type remain unknown. METHODS: Consecutive AF patients undergoing pulmonary vein isolation (PVI) by radiofrequency catheter ablation were enrolled from September 2014 to June 2018. The peripheral blood leukocyte NLR 1 day before and 36-48 h after PVI were measured. First, the relationship between NLR changes after to before ablation (ΔNLR) and ERAFs/LRAFs in PAF and PerAF patients were investigated to exclude the baseline inflammation status and evaluate catheter ablation induced inflammation. Second, the clinical impact of the NLR for predicting LRAFs was evaluated. RESULTS: There hundred sixty-nine PAF and 264 PerAF patients from Osaka Rosai AF registry were enrolled. The ratio of ERAFs/LRAFs in PAF and PerAF patients were 26.8%/22.5% and 39.4%/29.9%, respectively. In PAF and PerAF patients, the ΔNLR was significantly higher with ERAF than no-ERAF (p = 0.022 and p = 0.010, respectively). In PAF patients, the ΔNLR was significantly higher with LRAF than no-LRAF (p = 0.017), while with PerAF, the ΔNLR did not significantly differ between LRAFs and no-LRAFs. In PAF, the ΔNLR was independently and significantly associated with LRAFs after PVI (p = 0.029). CONCLUSION: The ΔNLR was significantly higher only in PAF patients with LRAFs than no-LRAFs, but not in PerAF patients. The ΔNLR was useful for predicting LRAFs after PVI in PAF patients.
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Yano et al. (2020) conducted an observational in Atrial fibrillation (paroxysmal and persistent) (n=633). Change in neutrophil-to-lymphocyte ratio (ΔNLR) was evaluated on Late recurrence of atrial fibrillation (LRAF) in paroxysmal AF patients (HR 1.13, 95% CI 1.01-1.26, p=0.029). The change in neutrophil-to-lymphocyte ratio (ΔNLR) after ablation was independently and significantly associated with late recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation (HR 1.13).
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